EP2514372A1 - Set of instruments for inserting a joint prosthetic, in particular knee prosthetic - Google Patents

Abstract

The equipment has a base frame (1) having a guiding plate and a laterally protruding primary gage, a fastening device on the bone, and a curved milling gage (7) having a main body (70) and a guiding piece, which is moved along a curved guiding path relative to the main body and has a receptacle for an abrasive tool. The aligning devices (17,77) place the curved milling gage in a clearly defined relative position when the curved milling gage is inserted into the base frame.

Description

The invention relates to an instrument for inserting a joint prosthesis, in particular a femoral component of a knee prosthesis, at the end of a bone, in particular of the femur.

The implantation of a modern joint prosthesis, in particular a knee prosthesis, is a challenging task for the surgeon. Such joint prostheses must reflect the complex physiological course of motion of the natural joint to a high degree true to nature. This not only requires sophisticated prostheses, but also precise implantation of the joint prosthesis. Only in this way can it be ensured that the desired functionality of the natural joint can be restored correctly. It goes without saying that in order to ensure a sufficient therapeutic success, the positioning of the prosthesis must not only be precise, but also safe and reproducible. In particular, it must not come to damage or injury surrounding tissue, especially surrounding bone material, as this plays a significant role in many cases for the support function. Especially with regard to a long life of the joint prosthesis, however, there is a conflict of goals. On the one hand, it is favorable for the long life, if the power transmission is rather large. On the other hand, it can, however, by a large area and thus to a large overall Dimensions of the prosthesis leading design to increased space requirements and thus easily cause damage to surrounding tissue. Thus, there is the danger that in the wrong areas, in particular for supporting the joint prosthesis important areas material is removed. It is therefore necessary to perform the implantation on the basis of exact position references.

Although the instruments known from the relevant prior art permit a proven implantation of the joint prosthesis, in particular a knee joint prosthesis. However, they require a considerable experience of the surgeon, since the instrumentation itself gives little assistance in terms of correct positioning.

In order to avoid deleterious effects on the patient due to incorrect positioning or removal of too much natural bone substance, the present invention has the object to provide an improved instrumentation, which allows a more precise implantation.

The object is achieved by an instrument with the features of the independent claim. Advantageous developments are the subject of the dependent claims.

In an instrument for inserting a joint prosthesis, in particular a femoral component of a knee prosthesis, at the end of a bone, in particular of the femur, the invention provides a base frame, which has a guide plate and a side protruding therefrom primary teaching, a fastening device for positionally fixed arrangement the base frame on the bone, a Bogenfräslehre with a base body and a guide piece, wherein the guide along a curved guide track relative to the base body is movable and it has a receptacle for a Abtragwerkzeug, and an aligning device which the Bogenfräslehre when inserted into the base plate in a clearly defined relative position sets.

The invention is based on the idea, by means of a base frame, which is positioned in a conventional manner in a fastening device on the bone to provide a stable and highly accurate by means of the alignment device platform on which the Bogenfräslehre is easy to use, and thereby automatically and safely is precisely aligned. The Bogenfräslehre has a curved guideway along which a corresponding rounded shape of the bone can be done by means of the Abtragwerkzeugs. This is particularly suitable for the preparation of a receiving seat for condylar components of the knee joint prosthesis. Their complicated shape, thanks to the invention by means of a forced operation, as achieved by the curved guideway of the Bogenfräslehre invention, be prepared in a simple yet accurate manner by the surgeon. Deviations in shape are hardly possible even under unfavorable operating conditions thanks to the positive guidance of the removal tool. This not only results in a high dimensional accuracy of the preparation thus created, but it is also ensured with correct basic orientation of the base frame, the positioning of the Bogenfräslehre uniquely determined by the alignment, also ensures that no injury or damage to surrounding tissue, especially no adjacent Bone material is removed unnecessarily, possibly needed to support the prosthesis. In particular, a wall-like bone residue can be left standing on Patellaschild so in knee joint prosthesis, which not only provides a basis for the patellar lateral support of the joint prosthesis, but also serves as a frontal delimitation of the box-shaped cavity of the medullary cavity for receiving the main body of the prosthesis.

In short, the invention enables a precisely defined removal of bone material on the basis of a clean basic positioning, whereby even complicated shapes, such as the varying curvature of the condyles in a knee joint, can be worked out in a simple and accurate position.

In particular, in order to adapt to the, as already mentioned above, non-constant curvature of the condyles, it is expedient if the curved guideway of the Bogenfräslehre changes continuously in its curvature along its extent. With such a change in curvature, the natural course of movement of the knee can be reproduced largely functionally. In this case, the geometry is preferably selected such that the respective center of curvature remains in a plane across the non-constant curvature along the guideway, whereby it shifts in the horizontal direction from anterior to posterior (preferably 10 mm, maximum 20 mm). The generation of a complicated curve with varying curvature, whereby the position of the center is still to meet certain requirements, is difficult with the existing instruments and is supported by these little or not at all. It came here in the prior art rather alone or mainly on the experience and the skill of the surgeon. With the instrumentation according to the invention it is ensured that always a precise design of the curvature profile can be achieved according to the specifications.

In order to achieve this, the guide piece in which the removal tool is received is expediently mounted pivotably on the base body via a follower with the guide track as well as via a rotary bearing. With this double bearing both the rotation of the guide piece along the guideway is controlled, as well as its orientation relative to the guideway. Thus, both the radius of curvature and the position of the center of curvature can be accurately controlled. It has proven particularly useful if the rotary bearing is arranged at a distance from the follower and has a toggle lever pivotably mounted on both sides. This results in a space-saving kinematics, which also linked precise leadership with avoiding jamming. Especially the latter is an important aspect, since it can easily come in the operation environment because of the ubiquitous risk of foreign body entry (especially tissue remnants or body fluids), especially in highly precisely managed technical facilities. The combination of a follower with a double-sided pivotally mounted toggle lever is robust in this regard.

It is particularly preferred if the toggle lever is detachably mounted on the base body via a fuse. This makes it possible to use the Bogenfräslehre with their base separately in the base plate, without being hindered by the movable over a large adjustment range guide. This is not just a simplification but allows for better handling. This is especially true in the case when, due to low tolerances, the insertion of the Bogenfräslehre is difficult, the force required for this can optionally be applied with a hammer. Thanks to the removability of the guide then there is no risk during the driving of the body to damage the decisive for accurate positioning guide with its guideway.

In order to avoid a cumbersome mounting of the guide piece in the operating environment and also to prevent the risk of losing individual assembly parts, a quick coupling between the guide piece and the base body is expediently provided. Has proven particularly useful as an angle lock, which can be separated by moving the guide into an extension of the guideway. An extension here means a region of the guideway that is not required for the actual shaping by means of the removal tool (but represents an unused additional area, so to speak). By the guide piece is brought into this extension, the angle lock comes in such a position that it can be easily and without tools separated. The same applies to the assembly, which can be done easily and without tools in the same way. For this purpose, the guide only needs to be brought into the extreme position in the extension, to be separated or replaced. In the region of the extension, this is expediently identified by the fact that there is an opening of the guideway to the outside. Although this opening is absolutely necessary, it does not make it easier to remove the guide in this position. It is understood that this opening in the Incidentally, not belonging to the extension area of the guideway is accordingly not available.

The angle lock may consist of a rotary bearing sleeve and a non-circular pivot, which is designed so that the angle lock opens only in an angular position of the guide. This is achieved in such a way that the rotary bearing sleeve is open over a narrowing to one side. The non-circular pivot pin is designed so that it has different widths depending on the positioning. This width in a particular positioning is called the width in a given meridian. Thus, if the non-circular pivot pin has such a shape that substantially corresponds to a rectangle with short arcuate sides, then the width in the smallest width meridian equals the distance between the two long sides of the rectangle, and the width corresponding to the meridian largest width equal to the length of the longer side of the rectangle plus the bulges through the arcuate short sides. By the constriction is chosen so that although it is sufficient for the passage of the pivot in its meridian smallest width, but not for passage in a meridian largest width, the guide piece can be removed with its pivot only in such an orientation in which Pivot with its meridian smallest width can pass the constriction. This is according to the invention only then the case when the guide is in the position of the guide rail, which belongs to the extension. In the other positions on the guideway, the guide is locked, because there the width of the pivot is greater than the width of the constriction, so that the pivot can not be removed through the constriction can. This results in a simple and robust quick coupling, which is angle-controlled and thus ensures that the separation can only take place in a certain position. The mounting of the guide also succeeds easily, because it only needs to be inserted in the correct position in the extension of the guideway, the pivot with its meridian minimum width is easily performed by the constriction in the rotary bearing sleeve. Thus, a simple, tool-free locking is achieved by pushing the guide in its position.

The toggle lever is preferably also detachably mounted on the base body. This makes it possible to remove all moving parts. This is not only beneficial for the cleaning of the instruments, but also, as already stated, for the assembly of the body in difficult cases, without causing damage to the sensitive guides. Preferably, the holder of the toggle lever via a fuse, so that it is protected against unintentional release from the intended position. As a backup in particular a screw has proven.

The guide piece, which is movable along the guideway, defines an axis for the removing tool through its reception. The axis may be oriented so that it lies in the pivoting plane of the guide piece, but preferably it is skewed. Further preferably, this axis is also skewed to the line between follower and rotary bearing. A range between 10 ° and 35 °, more preferably between 15 ° and 30 °, has proved suitable for this purpose. This creates a kink reserve on the knee lever, the allows a more extensive change of the radius along the course of the guideway.

Preferably, the receptacle for the removal tool on the guide piece cooperates with a depth stop. Depth stop is here understood to mean a device which limits the penetration depth of the removal tool into the workpiece, in this case the bone on which the instrumentation according to the invention is used. Has proven an execution of the depth stop in such a way that it is a stepped seat, which is preferably open to one side. With the grading is achieved that a corresponding arranged on the deep cutter thickening rests there and thus forms a stop with respect to the penetration depth of the support tool. The lateral opening ensures that the ablation tool can be inserted directly from the side into the receptacle, without the need for awkward threading.

Although it may be sufficient in principle that only one receptacle is provided on the guide piece, it is particularly advantageous for knee prostheses for the formation of two condyles if a double receptacle is formed on the guide piece. Thus, the Abtragwerkzeug can be implemented after a condyle is formed, so as to form the second condyle at the other position. Dismantling or converting the Bogenfräslehre is not required, so that the precise positioning is maintained.

It has proven useful if the double receiver is designed on the guide piece in such a way that divergent axes result. Divergent means here that the removal tool points with its cutting head in the inserted state to the outside. Thus, the condyles can be given a physiological propensity that supports a self-centering function present in the natural knee joint.

However, the double recording is not absolutely necessary. It can also be provided that the guide piece with the rotary bearing and optionally with the knee lever from one side of the body to the other is remountable. Thus, the condyle can first be prepared on one side, and after being mounted on the other side, the other condyle can be prepared with the same receptacle on the guide piece. Since in this case the positioning of the Bogenfräslehre need not be changed with their body itself, the precise positioning is maintained.

On the main body and / or the guideway expediently fastening holes are provided. They allow to secure the positioning of the Bogenfräslehre, regardless of their inclusion in the base plate. Thus, the fastening security and thus ultimately the quality of the position accuracy are increased; In particular, it is possible to remove the base frame.

According to a particular aspect of the invention, which may deserve independent protection, various inserts are provided for the base frame. Thus, an alignment insert can be provided replaceably on the base frame, which is designed to receive an alignment body in a defined position. The alignment body can in particular be a bone clearing tool, in particular an awl or a rasp for opening the medullary canal. The guide described in the preceding paragraphs will usually be designed so that the receptacle for the removal tool is oriented with its axis so that the axis has a radial orientation. This means that it is essentially directed to the center of curvature. Alternatively, however, it can also be provided that the axis is oriented transversely to the plane defined by the curvature. This offers the advantage that the removal tool can be inserted from the side into the receptacle. With a sufficiently large ablation tool, both condylar forms can thus be formed on a femur with a movement along the guideway. Preferably, however, is a variant in which the guide piece with the rotary bearing and, where appropriate, the toggle lever from one side of the body to the other is ummontierbar. In this case, the removal tool is dimensioned such that only one condylar path, namely the respectively closest one, is formed. This offers the advantage of a more precise control and also makes it possible to give an inclination by an optionally slightly tilted axis in the recording of the guide piece of Kondylenbahn. Thus, a comparable result is achieved, as can be achieved with the diverging axes in the above-described guide piece with a double recording.

In order to achieve an independent attachment of the Bogenfräslehre on the bone to be processed, mounting holes may conveniently be provided on the base body and / or the guideway. They serve primarily as a substitute for the attachment by means of the alignment device to the base frame anchored in the bone, so that the base frame can be removed if necessary.

According to a further aspect of the invention, which may deserve independent protection, an ensemble of inserts are provided for the base frame, which are changeable in the guide plate can be accommodated. This is in particular an alignment insert, a frontal saw insert, a first milling insert, a second milling insert and a third milling insert with a slotted guide.

The alignment insert is adapted to be arranged to be changeable in a defined position on the guide plate, wherein it has a receptacle for the alignment body. Thus, the base plate can be uniquely positioned with respect to the alignment body. Conveniently, the alignment insert is side-dependent, that is, there is an alignment insert "L" for implantation of the left-sided prosthesis and an alignment insert "R" for implantation of a right-side prosthesis. It should be noted that, as supplements, it is additionally possible to provide a symmetrical auxiliary alignment insert that can be used in the same way on both sides.

The receptacle for the alignment body on the alignment insert is expediently open on one side. This is preferably accomplished by means of a constriction. This ensures that the alignment body (usually this is an inserted into the medullary cavity of the bone instrument, such as an awl or a milling cutter act) can be easily inserted from the side into the receptacle or removed from this ,

Furthermore, the ensemble of inserts includes a frontal saw insert. This has two V-shaped aligned Sägellitze and a bipolar attachment. By bipolar attachment is meant a fixation defining two alternative attachment positions. These attachment positions are selected so that the saw slots are arranged once for implantation of a left-sided prosthesis and in the other case for implantation of a right-side prosthesis. An expedient embodiment for such a bipolar attachment may be two individual attachment holes, or preferably a slot whose endpoints define the respective bipolar attachment positions.

Preferably, the instrumentation further comprises spacers for different heights, which are designed for two-sided arrangement at the edge of the guide plate. With the spacers, a certain distance of the guide plate to the bone can be adjusted. This is particularly suitable for those cases where bone has already been removed as a result of previous surgery. In this way, the loss of material can be compensated. Preferably, spacers of different dimensions are included in the instrumentation.

Furthermore, the ensemble comprises a first milling insert, which is changeable in the guide plate attachable. It forms a defined receptacle for a broach, which preferably also forms a depth stop for the Räumfräser. This ensures accurate execution of the milling. In particular, this ensures that the Räumfräser does not migrate to the side and thus laterally or frontally or dorsally in an undesirable manner removes bone material. With The depth stop further ensures that bone material is removed only at the depth required for implantation. The distance of the receptacle to the primary gauge is dimensioned such that when the broaching cutter is inserted a distance remains which corresponds to the thickness of a wall to be left on the frontal side of the patellar plate. This is possible thanks to the forced guidance of the broach cutter, even in a confusing operating environment, even a less experienced surgeon.

Preferably, the instrumentation further comprises a feeler gauge, which can be attached at a plug-in receptacle to the base frame with angular accuracy. By means of this feeler gauge, the position of the pivot point of the prosthesis can be displayed, preferably in two planes of orientation.

Further, the ensemble comprises a second milling insert, which is changeable attachable to the guide plate. This has a double receptacle for the replaceable recording of a volume cutter. In this case, the double receptacle is preferably designed such that it has different depth stops and also a lateral offset. In this case, lateral displacement is understood to mean that the volume milling cutter is positioned differently in the one position of the double receptacle in the lateral-medial direction than in the other position of the double receptacle. The same applies to the depth stop, namely that the volume cutter achieves a greater depth of cut in one of the two positions than in the other position. The double receptacle is preferably designed such that their areas overlap. This ensures that created after milling a connected cavity in the bone. This forms the basis for Further elaboration in order to be able to produce a defined form for precise implantation. This allows a maximum space to be milled out without the risk of injuring the surrounding bone wall. It should be noted that the second milling insert may also be an auxiliary milling insert which likewise has a double receptacle. However, this double receptacle is simplified in the sense that it preferably has identical deep stops and / or has no lateral offset. This can be used to produce simpler structures for the cavity. This auxiliary milling insert is particularly useful if only a relatively small cavity needs to be worked out.

The ensemble further includes a third milling insert attachable to the guide plate. This forms a slotted guide for a depth cutter, which is preferably received in a slotted guide. With the slotted guide a fine shaping of the cavity can be achieved by means of the depth cutter. The scenery limits the movement of the depth cutter in the lateral-medial direction. Furthermore, it can be provided that the movement of the milling cutter in the frontal-dorsal direction is limited by means of a sliding window. Preferably, the gate slider has a handle which coaxially surrounds the depth cutter. This allows a more precise guidance of the depth cutter can be achieved. The slotted guide may have additional windows for visual control of the milling.

Preferably, the slotted guide has a depth stop. Thus, a second depth milling cutter can be provided, so defined by two different cutting depths are. This allows a secure and more precise development of even complex cavities.

In an alternative embodiment, it can also be provided that the slotted guide comprises two guide levers pivotally connected to one another. Here, the receptacle for the depth cutter can be arranged at one end, while at the other end of the articulated guide lever pivotally mounted on the insert is provided in the guide plate. This results in a more accurate guidance of the milling cutter in the sense of a positive guidance. Furthermore, this embodiment can have an advantage that a risk of jamming is reduced. Conveniently, the bearing on the insert is designed so that the articulated guide levers are only placed or separable when the Fräswerkinstrument is not used.

Preferably, an insertion guide is provided on the guide plate, which is designed in particular as a dovetail guide. Thus, the various inserts of the ensemble, as described above, can be easily inserted and precisely positioned with respect to the guide plate.

The instrumentation also includes advantageously a setting tongs for the Bogenfräslehre. This grips the Bogenfräslehre positively in a defined position, the jig on Ausrichtnasen with the aligning cooperates so that the jig is a unique position and thus the position of the jig held positively in unambiguous position Bogenfräslehre clearly positioned relative to the guide plate. This results in a considerable handling simplification, as in the Usually relatively large-sized Bogenfräslehre can be positioned so safely and accurately. An incorrect positioning is thus excluded.

The instrumentation expediently comprises remote alignment rods for lateral arrangement on the base frame in such a way that they point away from one another. Alignment holes are provided on lateral sides of the base frame for mounting these alignment bars.

Furthermore, the instrumentation includes a drill with a depth stop. He is trained to create positionally accurate and easy way on the bone recordings for Anankerunszapfen the endoprosthesis.

The instrument also includes various awls for clearing a cavity on the bone, especially a medullary cavity on the femur. Furthermore, it expediently comprises a rasp broach whose shaft has a recess. This is designed to receive a stop plate, which acts in particular as a depth stop. The rasp broach is expediently designed so that it has 2, 3 or 4 cutting edges. Here, the teeth are arranged on the cutting edges with a relative height offset from each other. This causes the teeth to remove bone material at different points during rotation, resulting in a smoothing of the bone surface.

The instrument expediently further comprises a straightening gauge, which is provided for positioning the base plate and engages the alignment device. In particular, it is designed to be in the medullary canal sticking rasp broach, and thus to position the base plate exactly in relation to this.

Fig. 1

eine Darstellung eines Basisrahmens;

Fig. 2

eine Reibahle;

Fig. 3

Elemente zum Ausrichten des Basisrahmens;

Fig. 4

Säge- und Fräslehren zum Vorbereiten eines Hohlraums am Ende eines Femurs;

Fig. 5

eine Kulissenfräslehre zur Feinbearbeitung des Hohlraums;

Fig. 6

Werkzeuge zur Vorbereitung eines Markraums;

Fig. 7

eine Bogenfräslehre umfassend einen Grundkörper;

Fig. 8

ein Führstück für die Bogenfräslehre gemäß Figur 7;

Fig. 9

einen Kondylenfräser eingesetzt in das Führstück gemäß Figur 8;

Fig. 10

eine Einsetzzange für die Bogenfräslehre in die Basisplatte;

Fig. 11

Einzeldarstellungen zur Anordnung des Führstücks am Grundkörper der Bogenfräslehre;

Fig. 12

eine Darstellung der Kinematik des Führstücks an dem Grundkörper;

Fig. 13

alternative Ausführungen des Führstücks;

Fig. 14

Einzelheiten zur Ausrichtung des Basisrahmens;

Fig. 15

Einzelheiten zur Verwendung von Ausgleichsstücken gemäß Figur 3;

Fig. 16

Einzelheiten zur Anwendung des Fräsers gemäß Figur 3;

Fig. 17

eine alternative Befestigung von den Abstandshaltern;

Fig. 18

Einzelheiten zur Verwendung der Sägelehre gemäß Figur 4;

Fig. 19

eine alternative Ausführung der Richtlehre;

Fig. 20

eine Frontalansicht zur Verwendung der ersten Fräslehre mit Fräser gemäß Figur 4;

Fig. 21

eine Alternative zur Verwendung des ersten Fräsers;

Fig. 22

Einzelheiten zur Anwendung der zweiten Fräslehre gemäß Figur 4;

Fig. 23

Einzelheiten zur Anwendung der Kulissen-Fräslehre gemäß Figur 5;

Fig. 24

eine alternative Kulissen-Fräslehre;

Fig. 25

Sicherungen für Einsätze; und

Fig. 26

Darstellungen zum Zusammenwirken von Sicherungen und Einsätzen.

The invention will be explained in more detail below with reference to the accompanying drawings, in which an advantageous embodiment is shown. Show it:

Fig. 1

a representation of a base frame;

Fig. 2

a reamer;

Fig. 3

Elements for aligning the base frame;

Fig. 4

Sawing and milling jigs for preparing a cavity at the end of a femur;

Fig. 5

a gate milling gauge for fine machining of the cavity;

Fig. 6

Tools for preparing a medullary canal;

Fig. 7

a Bogenfräslehre comprising a base body;

Fig. 8

a guide piece for the Bogenfräslehre according to FIG. 7 ;

Fig. 9

a Kondylenfräser inserted into the guide according to FIG. 8 ;

Fig. 10

an insertion pliers for the Bogenfräslehre in the base plate;

Fig. 11

Individual representations of the arrangement of the guide piece on the main body of Bogenfräslehre;

Fig. 12

a representation of the kinematics of the guide piece on the base body;

Fig. 13

alternative embodiments of the guide piece;

Fig. 14

Details on the orientation of the base frame;

Fig. 15

For details on the use of shims according to FIG. 3 ;

Fig. 16

For details on the use of the cutter according to FIG. 3 ;

Fig. 17

an alternative attachment from the spacers;

Fig. 18

For details on the use of the saw gauge in accordance with FIG. 4 ;

Fig. 19

an alternative embodiment of the gauge;

Fig. 20

a frontal view of the use of the first milling cutter with cutter according to FIG. 4 ;

Fig. 21

an alternative to using the first cutter;

Fig. 22

Details of the application of the second milling gauge according to FIG. 4 ;

Fig. 23

For details on the use of the gate milling gauge according to FIG. 5 ;

Fig. 24

an alternative scenery milling gauge;

Fig. 25

Fuses for inserts; and

Fig. 26

Representations on the interaction of fuses and inserts.

As an embodiment in the Figures 1-11 shown instrumentation for implantation of a knee joint endoprosthesis includes two awls 90, 91 (s. FIG. 14 ) and a rasp broach 92 (s. Fig. 2 ), a base frame 1, pins 99 as a fastening device on a femur bone, an alignment insert 3, a frontal saw insert 40, spacers 34, a feeler gauge 39, a first milling insert 4, a second milling insert 5, a third milling cutter Insert 6 as a slotted guide, and a Bogenfräslehre 7 with a Kondylenfräser 79th

The base frame 1 comprises a guide plate 12 and one of them orthogonal laterally projecting primary gauge 11. At the primary gauge 11 are in the upper region a first saw blade guide 20, which serves to compensate for different condyle heights, and formed in the lower region a second saw blade guide 21, which is for processing the Condyle when using femoral segments is used. Further, holes 22 are formed for fastening pins in the area between the saw blade guides. In the transition region to the guide plate 12 12 aligned mounting holes 26 are provided for spacers in the direction of extension of the guide plate.

The base frame 1 is provided in various sizes. Here, the distance between the reference plane 10 and the Saw blade guides 20, 21 and to the mounting holes 26 to the spacers identical for the different sizes.

The guide plate 12 is designed with its underside as a reference plane 10. This serves as a contact surface to condyles of the femur. At the top of a planarity is worked out, the tool level 14 acts. It is the reference plane for the various inserts that are received on the guide plate 12. In this case, the dimension between the reference plane 10 and the tool plane 14 is matched to the respective size of the implant to be used. On both sides of the tool plane 14, a linear guide 2 is arranged, which comprises two undercut edges between the tool plane 14 and the top of the guide plate 12. They act as a dovetail guide for the inserts 3, 4, 5 and 6.

On the guide plate 12 each have a milled recess 15 is formed on the lateral sides. It is designed so deep that the width remaining between them corresponds to the width of the width of the implant associated with the respective base plate 1. The milled recess 15 thus acts as a visual aid for selecting the implant sizes. In the milled recess 15 each have an alignment hole 23 is provided with an internal thread, which indicates the position by means of an alignment rod 38 to be screwed. Flanking the milled holes 15 holes 28 are provided for mounting pins 99. In the central region of the guide plate 12, a central opening of an approximately rectangular basic shape is formed, which at its two lateral side facing lateral surfaces as a lateral boundary 66 and with their remote from the primary gauge edge 65 as a rear boundary for a box milling works. In the lateral sides 66 guide slots 17 are formed for a Einsetzinstrument 76 of the Bogenfräslehre 7. Adjacent thereto, drill guides 18 for a pinhole bore are provided on both sides in the guide plate 12. In the rear region near the rear boundary 65 for the Kastenfräsung a posterior saw blade guide 19 is designed for Kondylenbearbeitung. At the opposite end of the large central opening, a diagonal alternating guide 16, 16 'oriented parallel to this is formed in the end facing the primary gauge 11. It has at its respective side surfaces a double arc shape and thus forms a bipolar receptacle for the frontal saw insert 40. This is for processing for a left-hand position in the position indicated by the reference numeral 16 and for processing a right-hand implantation in the reference numeral 16 ' designated positioning used.

Above the primary gauge 11, a central fastening 14 is centrally provided on the base plate 12. It serves to fasten the individual inserts. It is always in the same position for the different sizes on the base frame 1, so that the different inserts can be easily used with base frame 1 of different sizes. On both sides thereof free working 29 are formed, which create the necessary space for mounting pins on the Bogenfräslehre 7 to their attachment to the femur.

The rasp scraper, indicated generally by reference numeral 92, includes a plurality of cutting edges 93 in its lower portion, each provided with a plurality of teeth 94. To those provided with the teeth 94 Cutting edges 93 adjoin upwardly a tooth-free region 95 of reduced diameter. Above this, a recess 96 is formed. This serves as a receptacle for a stop plate 97. The cutting edges 93 are preferably designed in a triangular configuration, which means there are three cutting edges 93 which are arranged at an angular distance of 120 °. It should be noted that a different number of cutting edges, in particular two cutting edges or four cutting edges could also be provided (see illustrations in FIG Fig. 2b ). At the in Fig. 2a In the illustrated embodiment, the arrangement of the teeth 94 is selected so that the teeth 94 of a cutting edge 93 are offset in height from the tip of the rasp broach 92 to teeth 94 'of the adjacent cutting edge 93'. This has the advantage that with the rotation of the rasp broach 92 a more uniform design of the bone wall is achieved. It is specifically designed to preserve the bone in the near-edge area. For this she has a flattening, with which she is oriented to the bone. After insertion into the depth of the medullary cavity and rasping, it is then used as a reamer.

The rasp broach 92 functions with its upper shaft region above the groove 96 as an alignment aid and acts together with the alignment insert 3. This has an opening 31 which is open via a constriction 31 'to the side. Therein, the rasp broach 92 with its recess 96 can be introduced into the opening 31 by being inserted through the constriction 31 '. Thereby, a relative positioning between the rasp-Räumahle 92 and the base plate 1 is achieved, in which the alignment insert 3 is inserted. The alignment rods 38 are in the alignment holes 23 screwed in and show the surgeon the position of the base frame and thus act as an alignment aid. In the illustrated embodiment, the opening 31 is not oriented orthogonal to the reference plane 10, but is at an angle to her. The deviation from the orthogonal direction is referred to as the shank angle α and a characteristic measure of the prosthesis (6 degrees in the example). To visualize the surgeon this Schaftwinkel, an opening 30 is further formed on the alignment insert 3, which is formed on a projecting beyond the front boundary of the base plate 1 tongue through this opening 30 is a stylus 30 'inserted, which outside the Femur is to be machined and the surgeon thus indicates the shaft angle of the rasp in the medullary space of the femur to be machined rasp 92 (see Fig. 1e and f).

The alignment insert 3 is chamfered in a wedge-like manner on its lateral sides 33 (wedge angle γ is 4 to 10 degrees, preferably 6 degrees), at least by the shank angle α. This results on the one hand a sufficiently accurate positioning in the linear guide 2, and on the other hand - unlike a real dovetail guide - the use are taken upwards, at the end of the alignment process (s. Fig. 14 ).

It should be noted that with a Räumfräser 37, which optionally has a puncture 37 'similar to the recess 96 on the rasp-Räumahle 92 and according to the constriction 31' is inserted into the opening 31, a pre-processing a cavity in the medullary cavity of Femur can be made (s. Fig. 16 ). The broaching cutter 36 is tilted by the same shank angle α as the rasp broaching tool 92. This makes it possible to mill a deep area for the stem of the prosthesis. The maximum depth of cut is limited by a depth stop 37 "designed as a shank collar, so that the necessary excavation can be made deep in the bone, at the correct angle, without the need for special skills on the part of the surgeon.

As a rule, the base frame 1 will rest with its reference plane 10 directly on the end of the femur. However, this is not always the case, but especially in cases of reoperation and in other cases where bone material is already missing (if it was abraded in a previous operation or is missing due to a defect), spacers 35 may be provided on the underside 10 of the base plate 1 be arranged (s. Fig. 3 ). These are designed in pairs and are mounted on mounting pins 36, which are inserted into the mounting holes 26, on the primary gauge 11 of the base plate 1 (s. Fig. 15a ). They are in different thicknesses (s. Fig. 15b ), so that fine adjustment can be made hereby. Alternatives for the spacer are in Fig. 17 shown. The simplest is that at the edge of the base frame adjusting screws are arranged (s. Fig. 17a ). Alternative spacers 35, 35 'may also be provided for the substructure, which are held in a form-fitting manner on the lateral sides via hook or pin connections (see FIG. Fig. 17b and c ). These can be provided in the lower area with pin openings for the insertion of mounting pins 99 (s. Fig. 17d ).

Now, if the position of the base frame 1 is defined by means of the alignment insert 3, this is by introducing the fixing pins 99 fixed in the openings 28 relative to the femur. The alignment insert 3 and the rasp broach 92 can now be removed. The aids used for positioning, in particular the alignment rods 38 and the stylus 30 'are also removed.

By means of a known per se and not described in detail bone saw can now be made using the posterior saw blade guide 19, a processing of the condyles at the dorsal end (s. Fig. 18c ). In the next step, the frontal saw insert 40 is inserted into the corresponding diagonal alternating guide 16, 16 ', depending on whether it is an implantation on the left side or the right side. The orientation given by the double-arc-shaped recess 16, 16 'is defined by the bipolar fixing by means of the oblong hole 42, in the end positions 43, 43' of which a fastening screw 13 is screwed into the central fastening 14. It is now along the V-shaped saw blade guides 41, 41 ', the frontal Kondylenseite processed by means of the known bone saw (s. Fig. 18a, b ).

In the next step, by means of the feeler gauge 39, which is inserted into the slot 27 on the base frame 1, the plane of rotation in one direction and by insertion into the kerf 40, 40 ', the plane of rotation in another direction oriented transversely thereto can be determined. The point of rotation is determined by the intersection of the planes of rotation. An alternative instrument is in Fig. 19 shown. It comprises a bridge girder as straightening gauge 39 'with tabs 39 "arranged on both sides. The bridge girder 39' is inserted into receiving slots 17 on the base frame 1, and by the form-locking connection thus produced Connection, the orientation of the base frame 1 can be adjusted. The length of the indexing tongues 39 "is dimensioned such that they indicate with their end the respectively resulting position of the pivot point Z (see FIG. Fig. 19b and c ). This allows a fast and easy to control alignment.

In the following step, the first milling insert 4 is inserted into the base frame 1 and fixed by means of the central attachment 14, which is accessible through an opening 44, and the fastening screw 13. The insert 4 has a large central opening 45 with an upwardly projecting guide sleeve 45 ', which form a receptacle for a broaching cutter 49. This has in its upper region a collar 49 ', which cooperates with the upper edge of the guide sleeve 45' such that a depth stop for the Räumfräser 49 is formed. Thus, a portion of the cavity required for implantation is created in the medullary cavity, and on the other hand, the wall left by the reamer is reduced in height in the front region (see FIG. Fig. 19 ). - The reduction of the height of the wall in the front area can alternatively be done by a bit 46, as in Fig. 20 shown. The chisel 46 has a circular arc segment-like basic body with a also acting as a depth stop percussion head 46 'at the rear end. In the base frame 1, a guide slot 47 complementary to the cross-sectional shape of the bit 46 is provided on the primary gauge 11.

In the following step, the first milling insert 4 is exchanged for a second milling insert 5. This has a double receptacle 51, which is achtförmig in cross section and two receiving positions 52, 53 forms for a volume cutter 59. The two shots 52, 53 are not centered, but both with different offset to the side (Lateralversatz) arranged. Each of the two receiving positions 52, 53 is associated with an upwardly projecting sleeve 52 ', 53'. The volume milling cutter 59 likewise has a projecting collar 59 'in its upper region, which cooperates with the upper edge of the sleeve 52', 53 'associated with the respective receptacle 52, 53 and thus forms a depth stop for the volume milling cutter 59 (see FIG. Fig. 22a ). Thus, a large part of the cavity can be preformed for receiving the implant. It should be noted that the second milling insert 5, just like the first milling insert 4, is uniquely positioned on the base frame 1 by means of an opening 54 aligned with the central fastening.

Due to the different depth stops of the two receptacles 52, 53 of the double receptacle 51, an efficient evacuation of the cavity in the bone can be achieved. If this is not necessary, then a simplified second milling insert 5 'can be provided, which has a double receptacle 55 without lateral offset. Nevertheless, the depth stops can be at the same height (s. Fig. 22b ); but it should not be excluded that they are of different heights (as shown in Fig. 22a ).

It should also be noted that the second milling insert 5 is contained in two versions in the instrument. One version is designed for left-sided implantation and a second version, which is mirror-symmetrical, for right-sided implantation (see the second milling inserts 5, marked "L" and "R" in FIG Fig. 4 ).

In the following step, the second milling insert 5 is replaced by a third milling insert 6, which is designed as a gate insert (s. Fig. 5 and 23a-c ). This has two T-shaped oriented backdrop windows 60, 61 and two observation windows 62, 63. The backdrop window 60 is formed as a slot and acts as a receptacle for the fastening screw 13, by means of which the slide insert is guided on the base frame 1. Thus, the backdrop insert 6 can be moved back and forth to frontal and dorsal. In the transversely oriented gate window 61, a slotted guide 65 is slidably inserted, which has a handle 64 with a receptacle 67 for a milling tool 68, 69. The milling tools 68, 69 are a front and an end mill, by means of at different distances to Tip arranged stop collar 68 ', 69' are designed for different cutting depths (s. Fig. 5 and Fig. 23c ). They can be pushed through a central opening 67 in the handle 64 in the slotted guide 63. By moving the slotted guide 63 along its slide window 61 and moving the slide insert 6 along the slide window 60 (x / y movement), a rectangular cavity cross-section can be milled with high precision. Thanks to the precise slotted guide, the cavity can be produced with a high degree of dimensional accuracy, thus preparing the box-like receiving space for the knee prosthesis in the femoral cavity.

An alternative embodiment for the gate insert 6 is in Fig. 24 shown. It is a hinge insert 6 '. It has two articulated guide levers 60 ', 61'. With one end, they are rotatably supported by a pivot pin 62 'on a base plate of the insert 6', and at the other end a receptacle 67 'for the milling tools 68, 69 is formed. On the base plate of the gate insert 6 'is a U-shaped slide track 63' is formed, in which in the receptacle 67 'inserted milling tool 68, 69' is positively guided by the guide lever 60 ', 61'. The pivot pin 62 'is provided with a flattening 64', so that the guide lever 60 ', 61' can be placed on it or removed from it only in a predetermined mounting position. The flattening 64 'is aligned so that in the mounting position the receptacle 67' is off the slide track 63 '. This ensures that the assembly or disassembly can only be made when the milling tool 68, 69 is removed.

An additional securing of the inserts 3, 4 and 5 in the base frame 1 is in Fig. 25 shown. The securing opening 14 on the base frame is made in duplicate, namely a left-side 14 'and a right-side 14 ". The mounting openings 34, 44 and 54 on the inserts 3, 4 and 5 are designed as grooves 32', 34" running to the edge and laterally offset from each other, depending on whether the respective use for left- or right-sided implantation is provided. A safety lever 66 'includes a knob 66 "at the end of a stub shaft Fig. 25b can be inserted from one side into one of the fastening openings 14 ', 14 "by turning the securing lever 66' so that the knob 66" is transversely set, whereby a locking is achieved. In order to avoid accidental actuation of the safety lever 66 ', a securing bolt 14''' is preferably provided, which is inserted from the side into the base frame 1 and flush with a flattening 66 '''of the stub shaft such that the stub shaft and prevent the locking lever 66 'from rotating. The safety lever 66 'can only be adjusted again when the safety catch 14''' is removed. Conveniently, the corresponding inserts are on their underside with an undercut bore 50 'in the case of an against lifting to be secured insert 5' (s. Fig. 26a ) and / or with the groove 34 ', 34 "and a widened end in the case of an insert 3' to be secured against displacement (see FIG. Fig. 26b ) Mistake. Shown in the two smaller figures in each case the open position (above in Fig. 26a or left in Fig. 26b ) and the closed position (lower In Fig. 26a or right in Fig. 26b ).

After the preparation of the box-shaped receiving space in the femur, the processing of the slideways follows the condyles. It is especially on Fig. 7 to 10 Referenced. It is used by means of a setting tongs 76. It comprises two pincers halves 78, which has at its front ends two positively cooperating with the Bogenfräslehre 7 gripper 79. On the outside of each other pioneering alignment lugs 77 are formed. They are designed so that they are congruent to the shape of the guide slots 17 on the base frame 1. Thus, by inserting the setting tongs 76 in the base frame 1, wherein the alignment lugs 77 engage positively in the guide slots 17, a precise positioning of the Bogenfräslehre 7 relative to the base frame 1 ensures (s. Fig. 10 ). It should be noted that the Bogenfräslehre 7 in different (preferably four) sizes is available, the positioning by means of the setter 76 by interlocking engagement in the Guide slots 17 regardless of the size used in each case takes place in the same way.

The Bogenfräslehre 7 comprises a main body 70 whose basic shape corresponds approximately to a cuboid box (s. Fig. 7 ). On its lateral sides are formed vertically from top to bottom extending grooves 71. They serve for firmer and position-retaining anchoring in the cavity of the femur. On the upper side of the base body 70 an upwardly projecting circular arc segment 72 is integrally formed, which covers an angular range of about 100 to 120 degrees and is pulled down in the front region to about half the height of the base body 70. In the region near the edge, it has on one of its side surfaces a recessed guide track 74. It is bounded by a web 75 to the upper edge of the circular arc segment 72, wherein in the pulled-down front region, an extension 74 'of the guideway 74 is formed, which is free of webs. This creates an opening through which a follower 84 of the guide piece 8 can be inserted or removed from the guide track 74. This can be done only in the position when the follower 84 is in the region of the extension 74. At the other, rear end, the guideway 74 is closed and forms a stop 76 for the follower 84th

From a rear side of the main body 70, a double slot 77 extends to the top of the main body 70. Transversely to a receiving bore for a locking screw 79 is arranged. It acts as a pivot bearing 78 for a toggle lever 80, whose free end protrudes from the base body 70 and which is pivotable along the double slot 77 (s. Fig. 7 ). At its free end, the toggle lever 80 carries a pivot 81 whose cross-section is approximately rectangular with straight long sides and circular arc convex short sides is (s. Fig. 11a ). Between the arcuate convex short sides of the pivot 81 has a meridian largest width D and between the straight sides of a meridian smallest width d.

The guide piece 8 is generally T-shaped with a transverse segment 89 and a longitudinal segment 88 (see FIG. Fig. 8 ). At the transverse segment 89, in each case a stepped bore 87 with a circumferential shoulder are arranged in the outer regions. They are oriented with their axis 87 'so that they form an angle α of 75 to 85 degrees, preferably 80 degrees to the transverse segment 89. This diverge the axes 87 '. The stepped bore 87 forms a guide for a Kondylenfräser 85 which is inserted through a lateral opening 82 in the stepped bore 87. The condyle milling cutter 85 comprises a milling head and a shank, on which a cylindrical thickening 86 spaced from the milling head is formed. By resting on the circumferential shoulder of the stepped bore 87, it limits the depth of cut.

The longitudinal segment 88 of the guide piece 8 is angled; it forms an angle of about 15 to 25 degrees, preferably 20 degrees to the plane spanned by the axes 87 '. At the longitudinal segment 88, the follower 84 is arranged laterally, which guides the guide piece 8 along the guide track 74. At the free end, the longitudinal segment 88 is forked and provided with a transverse bore, which acts as a rotary bearing sleeve 83. It is open over a narrowing 83 'to the free end. The width of the constriction 83 'is dimensioned so that it is larger than the meridian smallest width 82 and smaller than the meridian largest width 82'. Are the rotary bearing sleeve 83 and the pivot 81 oriented so that the Narrowing 83 'meets the meridian smallest width 82, the guide piece 8 can be pushed with its pivot sleeve 83 on the pivot pin 81, and in any other orientation of the pivot pin 81 is prevented from passing through the constriction 83'. This results in an angle lock that can be opened or closed only in one position and is locked in the rest (s. Fig. 11a and b ).

The pivot pin 81 is oriented on the toggle lever 80 such that coupling or removal of the guide piece 8 can only take place in an extended position when the guide piece 8 forms a line with the toggle lever 80 (see FIG. 11a ).

Once the coupling has taken place, the guide piece 8 with its follower 84 is inserted into the guide track in the region of the extension 74 ', wherein the guide piece 8 is in an angled position relative to the toggle lever 80 (ie no longer stretched). Thus, the pivot 81 is prevented from passing through the restriction 83 '. The inserted into the guideway 74 guide 8 is thus securely locked to the toggle 80 (s. Fig. 11b ).

The kinematics achieved for the guidance of the Kondylenfräsers 85 is in Fig. 12 shown as a multiphase diagram. Down in the middle of the picture, the pivot bearing 78 is shown. It forms a fixed pivot point for the cam guide consisting of guide track 74, guide 8, and toggle lever 80 is. The guide piece 8 is guided over its follower 84 over the entire pivoting range along the guide track 74. The guideway 74 has a (in the figure from left to right) increasing curvature, whereby the radial distance enlarged between pivot bearing 79 and follower 84. As a result, not only the inserted into the guide 8 Kondylenfräser 85 always further away from the pivot bearing 79 (so he describes a continuously increasing arc), but it also changes its orientation. By the articulation on the knee lever 80, the guide piece rotates, so that the axis 87 for the cutter 85 is indeed directed to the pivot bearing 78 at the beginning of the pivoting movement, but in the movement of the guide piece 8 along the guideway always dorsal (in Fig. 12 right). Thus, the cutter 85 produces a condylar shape on the bone, whose instantaneous rotational pole is not stationary during the flexion of the knee joint, but rather shifts to the dorsal direction. Thus, a movement course is possible for the implanted with the instrumentation of the invention knee prosthesis, which corresponds to that of the natural knee practically fully and thus physiologically extremely favorable. Such implanted knee prostheses offer the best prerequisites for long-term therapeutic success, without the need for revision surgery after a short time.

An alternative embodiment of the guide piece for another condyle milling is in Fig. 13a, b shown. Here, guides 8 ', 8 "are provided which receive a horizontal cutter 85', 85". At the in Fig. 13a illustrated variant of the horizontal cutter 85 'from the side in the guide piece 8' and stored there on one side. The motion kinematics corresponds to those in Fig. 12 shown. The in Fig. 13b The knee lever and the guide piece 8 "are arranged on the outside, and the horizontal cutter 85" is inserted through the guide piece 8 " Retrofit 8 "for machining the other side.

The instrument set further includes a set of teeth for the creation and preparation of a prosthesis receptacle in the femur. The Ahlensatz (s. Fig. 6 ) includes an access eyelet 90 which serves to open the medullary cavity of the femur. By means of reamers 91, which are preferably contained in different lengths and diameters in the set, the medullary cavity is successively increased. Further, the special rasp broach 92 is provided with the stop plate 97, which have already been described above. Finally, a pinhole drill 98 is provided with a stop which is inserted into the drill guides 18 for forming receptacles for anchoring pins (not shown) on a condyle part of the knee joint endoprosthesis.

Claims (39)

Instrumentation for inserting a joint prosthesis, in particular a femoral component of a knee prosthesis, at the end of a bone, in particular of the femur, comprising a) a base frame (1) which has a guide plate (12) and one of which laterally projecting primary gauge (11), b) a fastening device (99) for the positionally fixed arrangement of the base frame (1) on the bone, c) a Bogenfräslehre (7) having a base body (70) and a guide piece (8), wherein the guide piece (8) along a curved guide track (74) relative to the base body (70) is movable and there is a receptacle (87) for a Abtragwerkzeug (85), and d) an alignment device (17, 77), which sets the Bogenfräslehre (7) when inserted into the base frame (1) in a clearly defined relative position. Instrumentarium according to claim 1, characterized in that
the arcuate guideway (74) has a non-constant curvature which preferably varies continuously along the guideway (74), preferably with the respective center of curvature (Z) moving dorsally a distance of 2 to a maximum of 6 mm [if the centers of curvature should remain stationary, please correct]. Instrumentarium according to claim 1 or 2, characterized in that the guide piece (8) via a follower (84) with the guide track (74) and via a rotary bearing (81, 83) is pivotally mounted on the base body. Instrumentarium according to claim 3, characterized in that
the rotary bearing (81, 83) from the follower (84) is arranged spaced and has a pivotally mounted on both sides toggle lever (80). Instrumentation according to claim 3, characterized in that the toggle lever (80) is detachably mounted on the base body (70). Instrumentarium according to one of claims 3 to 5,
characterized in that
the guide piece (8) is designed to be removable. Instrumentarium according to claim 6, characterized in that
an angular locking between the guide piece (8) and the base body (70) is provided, which can be separated by moving the guide piece (8) into an extension (74 ') of the guide track (74). Instrumentarium according to claim 7, characterized in that
the angle lock comprises a rotary bearing sleeve (83) and a non-circular pivot (81), which opens only in an angular position of the guide piece (8). Instrumentarium according to claim 8, characterized in that
the pivot bearing sleeve (83) is open to the side via a restriction (83 '), the pivot (81) having a minimum (d) and a maximum (D) meridian width, and the width of the throat (83') for passage the meridian smallest width (d), but not the largest width (D), sufficient. Instrumentarium according to one of claims 3 to 9, characterized in that
the receptacle (87) defines an axis (87 ') for the ablation tool (85) that is oblique to the line between follower (84) and rotational bearing (81, 83), preferably in the range between 10 and 35 degrees, more preferably between 15 and 30 degrees. Instrumentarium according to claim 10, characterized in that
the receptacle (87) for the removal tool (85) on the guide piece (8) cooperates with a depth stop. Instrumentarium according to claim 11, characterized in that
the depth stop is designed as a stepped seat in the receptacle (87), which is preferably open to one side. Instrumentarium according to claim 10, 11 or 12, characterized in that
the guide piece (8) has a double receptacle for the removal tool (85). Instrumentarium according to claim 13, characterized in that
has the double receiving diverging axes (87 '), so that the removal tool (85) faces outward in the inserted state. Instrumentarium according to one of claims 3 to 9, characterized in that
the guide piece (8) with the rotary bearing (81, 83) and possibly the toggle lever (80) from one side of the base body (70) are remounted to the other. Instrumentation according to one of the preceding claims, characterized in that provided on the base body (70) and / or the guide track (74) mounting holes. Instrumentarium according to one of the preceding claims, characterized in that on the guide plate (12) an alignment insert (3) is arranged exchangeably in a defined position, which is adapted to receive an alignment body, preferably a Knochenräumwerkzeugs (92). Instrumentarium according to claim 17, characterized in that the receptacle (31) for the alignment body is open on one side. Instrument set according to one of the preceding claims, characterized in that it comprises a frontal saw insert (40) having two V-shaped aligned saw slots (41) and a bipolar attachment (42, 43). Instrumentarium according to one of the preceding claims, characterized in that it comprises spacers (35) at different heights, which are designed to be arranged on both sides of the edge of the guide plate (12). Instrumentarium according to one of the preceding claims, characterized in that a first milling insert (4) is replaceable on the guide plate (12) attachable, which forms a defined receptacle (45) for a broaching cutter (49), preferably the cutter (49 ) holds in one position and forms a depth stop. Instrumentarium according to one of the preceding claims, characterized in that it comprises a feeler gauge (39) which can be inserted at a precise angle into a plug-in receptacle (27) on the guide plate (12). Instrumentarium according to one of the preceding claims, characterized in that a second milling insert (5) is replaceable on the guide plate (12) attachable, which forms a double receptacle (51) for the reversible receiving a Volumenfräsers (59), wherein the double receptacle (51 ) preferably has different depth stops and lateral offset. Instrumentarium according to one of the preceding claims, characterized in that a second Hilfsfräs insert (5 ') changeable on the guide plate (12) is attachable, which forms a double receptacle (55) for the reversible receiving a volume cutter (59), wherein the double receptacle ( 55) preferably has identical depth stops and / or no lateral offset. Instrumentarium according to one of the preceding claims, characterized in that a third milling insert (6) can be attached to the guide plate, which forms a slotted guide (61) for a deep milling cutter (68, 69), the deep milling cutter (68, 69) preferably is included in a slotted guide (65). Instrumentation according to claim 25, characterized in that the slotted guide (65) has a handle (64). Instrumentarium according to claim 26, characterized in that a depth stop (67) is provided, which preferably interacts with the depth cutter (68) and a second depth cutter (69) in such a way that different milling depths are achieved. Instrumentarium according to one of claims 25 to 27, characterized in that a backdrop window (61) are provided, in which the slotted guide (65) can be accommodated. Instrument set according to one of claims 25 to 28, characterized in that the slide guide comprises two articulated guide levers (60 ', 61') arranged at one end of the receptacle (67 ') for the depth of cut (68) and at the other end pivotally mounted on an insert (6 ') on the guide plate (12). Instrumentarium according to one of the preceding claims, characterized in that the guide plate (12) has a linear guide (2), preferably a dovetail guide, for different inserts (3, 4, 5). Instrumentation according to one of the preceding claims, characterized in that it comprises Bogenfräslehren (7) in different sizes. Instrumentarium according to one of the preceding claims, characterized in that a setting tongs (76) for the Bogenfräslehre (7) is provided, which engages them positively in a defined position and on Ausrichtnasen (77) with the alignment device (17) cooperates so that the Bogenfräslehre (7) in clear relative position to the guide plate (12) is used. Instrumentarium according to one of the preceding claims, characterized in that it is laterally on the base frame (1) to be arranged, pointing away from each other Ausrichtstangen (38). Instrument set according to one of claims 1 to 33, characterized in that it comprises a depth-stop drill (98) for providing receptacles of anchoring pins of the joint prosthesis. Instrumentarium according to one of the preceding claims, characterized in that it comprises different awls (90, 91) for clearing out a cavity on the bone, in particular a medullary cavity on the femur. Instrumentation according to one of the preceding claims, characterized in that it comprises a rasp broach (92) whose shaft has a recess (96) with a reduced thickness, which is designed to receive a stop plate (97). Instrumentarium according to claim 36, characterized in that the rasp broach (92) has two, three or four cutting edges (93). Instrumentation according to claim 37, characterized in that teeth (94) are arranged on the cutting edges (93) with a relative height offset. Instrument set according to one of the preceding claims, characterized in that a straightening gauge (39 ') for positioning the base frame (1) is provided, which acts on the alignment device (17).

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